CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 347 234.000000 8648.7500 36.9605
Subtotal (Total Children Is Unduplicated) 347 234.000000 8648.7500 36.9605
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 8.500000 637.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 27 40.500000 3037.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 37 62.000000 4650.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 8.500000 471.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 61 94.000000 5217.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 8.500000 637.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 46 71.000000 5325.0000 75.0000
Subtotal (Total Children Is Unduplicated) 148 314.000000 21495.5000 68.4570
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 18 19.750000 987.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 3 5.250000 131.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 5 4.000000 200.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 1 1.000000 50.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 3 3.000000 75.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 12 9.500000 475.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 4 3.500000 175.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 8 7.750000 387.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 13 12.000000 600.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 4.000000 100.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 28 55.000000 2750.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 35 64.250000 3212.5000 50.0000
INTR-T1013-INTERPRETER 1 2.000000 100.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 14.000000 1000.1600 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 10 19.000000 1357.3600 71.4400
OCCT-97530TL-OT SESSION BY LICENSED OT 5 6.000000 428.6400 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 8 15.500000 1107.3200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 2 3.000000 214.3200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 6 11.000000 785.8400 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 9 17.000000 1214.4800 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 10 17.500000 1250.2000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 16 39.000000 2786.1600 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 3.000000 214.3200 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 8 10.000000 714.4000 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 3 5.000000 357.2000 71.4400
Subtotal (Total Children Is Unduplicated) 156 353.000000 20749.1500 58.7795
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Total 901.000000 50893.4000 56.4855
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Number of Children (Unduplicated) With at Least One Service 600
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Center 01
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 1 1.000000 50.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 575 499.500000 27901.9200 0.0000
H 119 131.750000 8539.2600 0.0000
T 1 2.000000 100.0000 100.0000
309 263.500000 14181.9700 0.0000
Other 3 3.250000 120.2500 0.0000
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Total 1008 901.000000 50893.4000 100.0000